Explaining the NFL concussion protocol

The NFL implemented a detailed review process a decade ago after NFL QB Colt McCoy took a vicious helmet-to-helmet hit and returned afterward without being evaluated for a concussion.

The process has ramped up the number of during-game tests players have received in recent years – oftentimes preventing them from returning during the game.  But the process is now under scrutiny again after Dolphins Quarterback Tua Tagovailoa appeared to take two hits to the head in a span of four days.

Here’s the NFL’s protocol as-adopted:

•  Any player who exhibits or reports symptoms or signs of a concussion or “stinger” enters protocol.

• Independent certified athletic trainers, or ATC “spotters” monitor players on the field for injuries. If they see a head impact, they call a timeout.  At that point, the player must leave the field for an examination and evaluation.

But team trainers, coaches, teammates, physicians, teammates and NFL game officials – both on the field and in the booth – also can initiate the protocol.

• Once in the protocol, a six-step evaluation is conducted by a team physician and UNC – an independent, unaffiliated neurological consultant – to determine the severity of the injury. That includes a neurological evaluation that consists of a cervical spine exam, including speech and gait observation, eye movements and an exam of the pupils to look for signs of a brain injury.  Range of motion is also tested.

If any single element yields a positive result, the player is taken to the locker room for a full neurological exam.

If abnormal, the player doesn’t return to play, undergoes periodic evaluation by a medical team and has a follow-up neurological exam.

“If the UNC disagrees with the team physician’s decision to return the player to play or remove the athlete, the UNC will be given an opportunity to explain the basis of his/her opinion. This will be discussed in a collegial fashion in private as to why that the player should or should not be returned to the game. The team physician will communicate his final decision to the player.”

The NFLPA has already raised concerns about the handling of Tua’s previous in-game injury against the Bills on Sunday and said it will pursue every legal option to review whether the Dolphins and the NFL handled the situation appropriately.